Provider Demographics
NPI:1770295057
Name:EAST VALLEY SURGICAL ASSISTING
Entity type:Organization
Organization Name:EAST VALLEY SURGICAL ASSISTING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LAURENT
Authorized Official - Last Name:LEVESQUE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:480-296-9893
Mailing Address - Street 1:5155 E. EAGLE DRIVE
Mailing Address - Street 2:# 20730
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85277-3031
Mailing Address - Country:US
Mailing Address - Phone:480-706-9430
Mailing Address - Fax:
Practice Address - Street 1:8540 E MCDOWELL RD
Practice Address - Street 2:UNIT 38
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-1419
Practice Address - Country:US
Practice Address - Phone:480-706-9430
Practice Address - Fax:480-378-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1407005549Medicaid
AZ1407005549OtherVA, PRIVATE INSURERS, BUREAU OF INDIAN AFFAIRS